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We are delighted to congratulate three of our MSc in Evidence-Based Health Care students, Stella Vieth, Andrew Dagens, and Sean Godfrey, having been awarded this year's EBHC Dissertation Prize for outstanding dissertations.

Our three 2022 EBHC dissertation winners

In light of this achievement, we asked our three winners to shared details of their dissertation projects. See below:

Stella Vieth's dissertation

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A cross-sectional questionnaire study about the state of knowledge, and drive of change in perception about the pill in women aged 18 to 29 years living in Germany.

The pill is the most used contraceptive method in Germany. However, many young women prefer other methods of pregnancy prevention. Previous studies have reported uncertainty and a lack of information about the pill. The aim of this study was to gain an understanding of young women’s  sources of information, attitudes towards, and knowledge of the pill, and the driving forces of change in contraceptive behaviour. 

Between September 2020 and April 2021, 2470 women aged 18 to 29 in Germany participated in an online survey. They were asked about their sources of information regarding the pill, their subjective knowledge and perceptions of the pill, as well as their trust in their gynaecologist. An objective knowledge quiz was included.  

Those informing themselves via the internet were less likely to overestimate their knowledge, while those reporting their gynaecologist as source of information were less likely to underestimate it. Both groups achieved very similar knowledge scores. This suggests a high degree of confidence in those getting their information from their gynaecologist, and uncertainty in those informing themselves via the internet.

Women who felt ill-informed or who underestimated their own knowledge held more critical beliefs about the pill and the information they received from their gynaecologist.

The findings of this study highlight challenges faced by the German health care system, including a lack of trust in medical science among some members of the population. Implementation and communication of evidence-based medicine into daily practice may help rebuild trust and facilitate informed decision-making.

 

 

Stella would like to thank her supervisor, Jamie Hartman-Boyce, for her assistance and encouragement in every step throughout this process, as well as Prof. Nicolai Maass, director of the department for Gynaecology and Obstetrics at the University Medical Center Kiel, who supported her with the study and facilitated the recruitment of local gynaecologists.

Andrew Dagens' dissertation

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The Diagnostic Accuracy of Rapid Diagnostic Tests for Ebola Virus Disease: A Systematic Review of Diagnostic Accuracy Studies.

Ebola Virus Disease, sometimes known as Ebola, is a dangerous illness that can cause severe fever, bleeding and even death. Ebola occurs most often in West Africa, where it occasionally causes large outbreaks. These outbreaks have caused enormous problems for the people of West Africa. In the last major episode, between 2014 and 2016, more than 11,000 people died. Many more became severely sick.

Patients with Ebola must be identified as soon as possible to prevent small outbreaks of Ebola from becoming major ones. Early recognition allows doctors to treat sick patients quickly and prevents the disease from spreading in the community.

Unfortunately, diagnosing Ebola can be very difficult. Ebola has quite vague symptoms and can mimic other conditions - such as malaria - which are common in West Africa. To make a firm diagnosis, doctors need access to a definitive test for Ebola, called PCR.

Sadly, access to PCR technology is limited in precisely those areas where Ebola is common. PCR requires an advanced laboratory and skilled laboratory staff, and there is a shortage of both in West Africa.

To overcome this problem, scientists have developed tests which aim to be as accurate as PCR but do not require a laboratory. Because these tests generate results much more quickly than PCR, they are called 'Rapid Diagnostic Tests,' or 'RDTs.'

Over the last decade, several small studies have explored the accuracy of RDTs for diagnosing Ebola. We combined these studies to get a combined estimate of just how accurate RDTs are. We found that RDTs sometimes miss cases of Ebola but are rarely positive unless the patient truly has Ebola. RDTs are equally effective on samples taken from a patient's blood, plasma or saliva. More work is needed to determine the best role for RDTs and their affordability.

Drew would like to thank his supervisor Dr Annette Plüddemann for her advice and guidance.

Sean Godfrey's dissertation

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The use of antipsychotic medications in children and adolescents with autism spectrum disorder: A systematic review and network meta-analysis.

Autism affects 1 - 2 % of all children and adolescents globally and many of them are treated with antipsychotic medications, often for months or even years at a time. Millions of prescriptions for these medications are written every year. However, there have been very few good quality studies published looking at either the efficacy or the side effects of these potent medications, in terms of randomised double-blind placebo-controlled trials.

There is a growing concern among both autism advocates and physicians working in the field of childhood autism that the current widespread trend of prescribing antipsychotic medications may have been influenced by exaggerated claims of their benefits from the drug manufacturers’ own funded trials; and that there has been a lack of focus in the literature on their potential harmful side effects.

Sean’s thesis summarizes the available evidence, and is the first systematic review to address the topic using the following evidence-based methodological approaches:

a)      it combines both a pairwise meta-analysis and a network meta-analysis of antipsychotic medications for both the primary efficacy outcome of a reduction in irritability, and for the secondary side effects of extrapyramidal symptoms, somnolence and sedation.

b)      it examines in detail the quality of the included studies in terms of the risk of bias using the updated Cochrane Risk of Bias 2 Tool. It also assesses the confidence in the evidence for the outcomes by GRADE assessments employing state of the art GRADEpro and CiNeMA software for the pairwise meta-analysis and network meta-analysis.

The review confirmed antipsychotic medications do have significant positive effects on reducing the key symptom of irritability; but there are significant risks of serious side effects. Important limitations in the included studies resulted in low confidence in the evidence for the outcomes. There were conflict of interest issues in most of the studies, as their authors were paid researchers of the drug manufacturers. There were no long-term studies of greater than 8 weeks duration found to support the use of these medications in this vulnerable population. The network meta-analysis provided more precise estimates of the comparative effects of the medications. The ranking system of the drugs it produced is an attractive concept; but given the low quality of the few studies that exist caution is required in terms of clinical application. Better designed long-term studies are required and were outlined to improve our evidence-based practice.

 

 

Sean wishes to thank his supervisor Dr Kathryn Taylor for her tremendous support and encouragement, and his fellow student, Lewis Yaxley, for his generous contribution as an independent secondary screener